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Good Evening
11:51:03 PM CDT
Sunday, April 20, 2014

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Utilization Review

Topics Forms & Publications Electro Medical Device Certification Request (M5)
General Information Utilization Review Guide Provider Request for Adjustment (M6)
Authorization Process Utilization Review Request (UR-C) Independent Exercise or Work Hardening/Conditioning Program Requests (C59a)
Physical and Occupational Therapy Treatment Window Utilization Review Request (UR-C) Guidelines Quick Tips for Physical & Occupational Therapists
Durable Medical Equipment (DME) Post Injection Pain Response Note  
Treatment Guidelines    

Treatment Guidelines

WSI utilizes the following evidence-based clinical guidelines from national and state authorities as outlined Administrative Rule 92-01-02-33 (5):

  • Official Disability Guidelines (ODG)
  • American College of Occupational and Environmental Medicine’s Practice Guidelines
  • Guide to Physical Therapy Practice
  • Medical Disability Advisor
  • Diagnosis and Treatment of Physicians and Therapist Upper Extremity Rehabilitation
  • Treatment Guidelines of the American Society of Hand Therapists
  • Other treatment and disability guidelines or standards it deems appropriate to administer claims.

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